The bill would let licensed Ph.D. psychologists who get extra training and pass a test prescribe from a set list of drugs to treat psychological conditions. Only Louisiana and New Mexico have similar laws.

Proponents hope that letting some psychologists prescribe drugs will increase the number of people who can get integrated mental health care, including drugs and therapy, especially in rural areas of Oregon.

“We need to expand access,” said Sen. Laurie Monnes Anderson, , D-Gresham, the bill’s main Senate proponent. “And there are many different ways, I feel, to deliver health care. This is just one more tool.”

A similar law has been proposed every legislative session since 2007, but none passed amid worry psychologists wouldn’t have enough education or oversight. So last year, a work group of three psychologists, three physicians and an expert on drugs and the brain drafted the new bill with a mediator’s help. Even that work group was controversial, with opponents of the law upset that one member runs a California-based distance-learning program for psychologists.

The group drafted a law that gives doctors checks over the psychologists: Psychologists who prescribe must work with a patient’s primary doctor to ensure a drug’s safety. And the Oregon Medical Board, which regulates physicians, would oversee the prescribing program instead of the state Board of Psychologist Examiners.

Even so, some doctors and even some psychologists worry about the safety of giving the power of prescription to a profession that studies basic science less than others who prescribe drugs. Groups including the Oregon Medical Association and Oregon Psychiatric Association opposed the law.

“We’re talking about behavioral professionals whose undergraduate training and graduate school training, for the most part, avoid the sciences,” said John McCully, the psychiatric association’s lobbyist.

Psychiatrists, like others with an M.D. degree, get extensive training in biology, organic chemistry, physiology and other sciences that help explain how chemicals affect the body. Other Oregon professionals who can prescribe drugs, including nurse practitioners and naturopaths, also get some training in those areas. While psychologists get doctoral degrees, they focus on social science.

The new law would require licensed psychologists to spend at least two years studying how drugs affect the brain and body, said Robin Henderson, an Oregon Psychological Association board member who helped negotiate the bill’s text. After that, psychologists probably will have to work under close supervision for a while before they are able to prescribe drugs on their own. Those educational requirements are steep enough that no one thinks many Oregon psychologists will seek a prescribing certificate.

“I would be surprised if, within a decade, 10 percent of psychologists in Oregon (there are approximately 1,300) do this,” Henderson said. She said young people just entering the psychology field might be more interested in getting the drug training than people with established practices.

Tanya Tompkins, an associate professor of psychology at Linfield College, has raised the issue of prescribing rights in seminar classes for years. Tompkins said many students initially support letting psychologists prescribe, but most wind up opposing the idea.

Freud's couchTompkins strongly opposes letting psychologists prescribe, in part because they get too little science training. She also worries about creating a new tier of psychologists who are cheaper than psychiatrists and who would get flooded with patients demanding prescriptions. Because insurers tend to pay more for drugs than counseling, she worries having prescribing psychologists will cause too many patients to get treated with drugs and too few with therapy.

And, Tompkins said, few prescribing psychologists wound up practicing in rural areas in Louisiana and New Mexico. Just 14 percent of licensed prescribing psychologists in those states live in communities of 25,000 or fewer residents, she said.

While only a handful of prescribing psychologists may work in rural areas, letting some psychologists give out drugs is still one of many changes that can offer good mental health care to more Oregonians, said Rep. Tina Kotek, D-Portland, the bill’s champion in the House. Kotek said Oregon needs to work harder to draw mental health workers, from licensed professional counselors to psychiatric nurse practitioners, to rural areas. She also said Oregon should expand “telemedicine” projects, in which psychiatrists from cities consult with psychologists in rural areas.

Gov. Ted Kulongoski has not yet decided whether to sign the bill, according to his spokeswoman, Anna Richter Taylor. If he does sign it, a committee of three psychologists and three physicians will give the Legislature, by March 2011, recommendations for what testing and education psychologists need, and which drugs they could prescribe. After that, a different committee with four psychologists and three physicians would advise the Oregon Medical Board about how to regulate the program.